Transcript
Webinar Wednesday June 13, 2012 ã 11 AM EST Presented by: David W. Woodruff,MSN, RN-BC, CNS, CMSRN, CENPresident, Ed4Nurses,
[email protected] ©2012 Ed4Nurses, Inc. All rights reserved 5 Steps to RhythmStrip Interpretation **NEW** Call in on your phoneor use your comput-er’s audio: check your email instructions. Need help connecting? Call (800) 990-2629 5 Steps to Rhythm Strip Interpretation© 2011 David W. Woodruff www.ed4nurses.com1 5 Steps to Rhythm Strip Interpretation Program description: Upon completion of this program, the learner will be able to rapidly identifycommon cardiac rhythms and be able to relate the appropriate treatment priorities for those rhythms. Objectives: 1. Describe the characteristics of a normal EKG complex.2. Identify the physiological characteristics of normal conduction.3. Use 5-steps to identify normal sinus rhythm.4. Compare and contrast EKG rhythms using a 5-step approach.5. Plan care for patients with abnormal EKG rhythms.All material in “5 Steps to Rhythm Strip Analysis is copyrighted 2003-2011 byEd4Nurses, Inc. Duplicating, reproducing and distributing are prohibited without writtenconsent from Ed4Nurses, Inc. 5 Steps to Rhythm Strip Interpretation© 2011 David W. Woodruff www.ed4nurses.com2 5 Steps to Rhythm Strip Interpretation As patient acuity increases, more patients are being placed on telemetry andnurses are being expected to be able to read EKG rhythm strips. However, this skill neednot be difficult to learn. It is best accomplished by a systematic method of analysis. The5 Steps to Rhythm Strip Interpretation systematically reviews the major components of arhythm strip to help determine the type of rhythm and the appropriate course of treatment. The 5 Steps are listed below: Step 1. Is the speed of the rhythm between 60-100? Step 2. Is it regular? Step 3. Is the complex narrow? Step 4. Is it preceded by a P-wave? Step 5. Do all the complexes look the same? Step 1 evaluates the speed of the rhythm to determine if it is normal, too slow or too fast.A speed between 60-100 maintains the best hemodynamic stability. Rates less than 60 or greater than 100, can lead to hemodynamic instability and become symptomatic. Step 2 asks if the rhythm is regular. Rhythms srcinating from the normal pacemakers inthe heart will be regular. Irregular rhythms indicate extra beats or abnormal rhythms. Step3 assesses the shape of the complex. A narrow complex is normal. A wide complexindicates conduction abnormalities. Step 4 asks if a P-wave precedes the QRS complex. This represents normal conductionfrom the atria to the ventricles. If the P-wave is absent, the impulse is being generatedfrom elsewhere in the heart. Step 5 assesses whether all the complexes look the same. Normal conduction follows thesame pathway with each beat. Different looking complexes indicate the some impulsesare following alternative or aberrant pathways.If the nurse can answer all of the questions asked by the 5-steps affirmatively, the patient has a sinus rhythm. The greater the number of questions answered negatively,then the greater the abnormal conduction through the heart. This usually indicatesmyocardial irritability.Spend a few moments to reacquaint yourself with the normal EKG complex, andits components. 5 Steps to Rhythm Strip Interpretation© 2011 David W. Woodruff www.ed4nurses.com3 Normal conduction Depolarization:Impulses begin at the Sinoatrial (SA) node, generating a P-wave. The impulse travelsthrough the electrical pathways to the Atrio-Ventricular (AV) node. The AV node delaysthe impulse, so that the atria and ventricles don’t fire at the same time. The delay is seenon the EKG as the P-R interval. As the impulse travels down the perkinge fibers in theventricles, it generates the QRS complex.Repolarization:In order for the heart to fire again, it needs to re-load. Electrical re-loading of the heart iscalled repolarization and is represented by the T-wave on the EKG.Figure 1
